1. Introduction

Biologically people are born as female or male; but they are later taught to exhibit certain behaviours, attitudes, roles, activities, expectations and desires of girls or boys and women or men as the case may be ^[1].These attributes of social construct describing the roles and behaviours of girls/boys or women and men, often referred to as gender ^[1], is today a major determinant of access to all forms of human endavour including health care ^{[1, 2]}. In an Ideal situation, healthcare providers should treat male and female patients equally, even when they have different needs. On the other hand, patients should have equal preference for trained and competent male and female physicians. However, preference for gender in terms of health provider patient relationship is by no means a new issue ^{[2, 3, 4, 5, 6]}.

Over the years, male preference in enrolment into medical institutions dominates that of the females thereby leading to a reduced number of female doctors and other female health care providers ^[7]. Recently, the biases in educational opportunities against females have changed with the strength of enrolment of females into medical institutions now on the increase worldwide ^{[7, 8, 9].} In the last two decades, the proportion of men who wish to become gynecologists worldwide is decreasing steadily ^[10]. Besides, the direction for male gender preference of health providers often dictated by culture, religion, ethnicity, race and even convenience have also changed in favour of female in most instances ^{[7, 8, 9, 10, 11]}. This significant change has received more attention in the areas of obstetrics and gynecology than elsewhere. This might be more pronounced in sensitive issues like sexually transmitted infections (STIs) where moral and cultural issues may circumvent client’s perception ^{[2, 5]}.

In developed countries most of the data on provider’s choice are more dependent on the providers attribute in terms of experience, communication style and technical expertise as compared to developing countries where most factors are culturally or socially based ^{[5, 12]}. Therefore, one of the most frequently asked questions in obstetric and gynecological practices today is whether the female patient population seen generally prefer female physicians, but quite often a large proportion of women did say they would rather see a female physician when given the choice. However, the apparent preference of patients may, purposefully or inadvertently, not imply that male Obstetrics/Gyneacology is not wanted ^{[3, 13, 14, 15, 16]}. In response to the issue most developed countries have made several important provisional efforts to provide client centered care, even though the particular role of gender as an underlying social basis in shaping the interaction between clients and health care providers still remains unclear ^[12]. This study therefore, assessed the preferred health provider genders and the associated determinant factors among women attending Obstetrics/Gyneacology clinic at Ahmadu Bello University Teaching Hospital, Zaria, northwestern Nigeria.

2. Methods

Ahmadu Bello University Teaching Hospital (ABUTH), Shika- Zaria is a tertiary health facility with about 1000 bed capacity, 550 staff strength and total annual admission turnover of about 10,000 patients. Obstetrics/Gyneacology department of the hospital provides reproductive health services to both male and female.

A cross sectional descriptive study was carried out from 6th January, 2010 to 19^th March, 2010 investigating 426 females attending Obstetrics/Gyneacology clinics.

The study participants were female patients who visit ABUTH within the period of study. All female OBs/GYN clinic attendees were included in the study, while the female patients who attend other clinics other than OBs/GYNs were excluded from the study.

A minimum sample size of 384 was obtained using the formula

^[17]

Based on the assumption of female doctor’s preference rate of 52 % from a previous study ^[18] and 5% degree of precision at 95% confidence interval. Considering attrition rate of 10%, the calculated minimum sample size was adjusted to 426.

Non probability sampling technique was employed for the study. Every patient who fulfilled the inclusion criteria and consented to participate was interviewed till the required sample size was met. In the study period, 620 eligible patients were consecutively approached, of which 426 consented to participate and were administered the questionnaire.

Closed ended interviewer administered questionnaire containing information’s on the participant’s socio-demographic profile, provider’s gender commonly seen, gender preferred if given the choice and reasons for the gender preference was used. The questionnaire was first prepared in English, then translated into the local languages (Hausa, Yoruba and Ibo), and then translated back to English to check for consistency and phrasing of difficult concepts. Trained research assistants were used to collect the data. Pre-testing was conducted with 43 patients (10% of estimated sample), at Barau Dikko specialist hospital Kaduna, about 76 km away from ABUTH. Questions causing difficulty in the pre-test were rephrased and corrected.

The main outcome variable for the study was "preference for health provider’s gender" (male, female or no preference). Reasons for the gender of the health provider preferred were also assessed. The independent variables for the main outcome were socio-demographic characteristics including age, religion, marital status, ethnicity and educational level of the respondents.

The data were analysed by use of statistical package for social sciences (SPSS version 17). Results were summarized and presented as contingency tables and chi square (x²) test was used for test of association between the socio-demographic variables and the main outcome of the study, with statistical significance set at p-value of 0.05. Risk analysis for selected independent predictors that have significant chi-square was performed using multiple logistic regression models by controlling for possible confounders. An odds ratio greater than one for a particular variable indicates that the study subjects in the category were more likely to prefer either male or female health provider than were respondents in the reference category.

Ethical clearance was sought from the ethical and scientific committee of Ahmadu Bello University Teaching Hospital, Zaria, and permission was obtained from the head of department of OBs/GYN. Consent was obtained from the participants after explaining the aims and objectives of the study to them in English and translated into Hausa and other languages where necessary. Literate respondents indicated acceptance by signing the consent form, while illiterate participants indicated by thumbprint.

3. Results

Of 426 OBs/GYN clinic attendees who consented to be administered the questionnaire; a total of 419 completed the study giving a response rate of 98.4%. The mean age of the respondents was 29.4 (± 11.2) years old and majority of them were Hausa (48.7%), followed by Yoruba (16.5%) and Igbo (7.2%). Regarding their educational level, two hundred and five (48.9%) had completed their secondary education, 25.3% had tertiary and 17.7% were primary school graduates. 21(5.0%) had Quranic education, while 3.1% had no education at all. Above half of the respondents (57.8%) were married and 26.5% were single (Table 1).

Table 1. Sociodemographic Characteristics of Respondents (n= 419)

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On issues of health providers commonly seen during visits; majority of the respondents who participated in the research are often seen by male doctors (70.4%), while less than one third (29.6%) are commonly seen by female doctors. About eighty one percent of them did not see either male or female health providers by choice. Two hundred and forty eight (59.2%) prefer to be seen by female doctors and 18.7% by male doctors (Table 2).

Table 2. Obstetrics/Gynaecologists commonly seen and Gender preferred (n= 419)

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Amongst 248 respondents who have preference for female health providers, their main preferential attributes for the female health providers were the health provider’s communication ability (79.0% ), religion (73.4%), knowledge of women health issues (63.3%), experience (62.9%), technical expertise (55.2%) and empathy (52.4%). On the other hand, all the respondents who prefer to be seen by male health providers attributed their choice to the technical expertise of the male health providers, while73 (93.5%) and 72(92.3%) attributed it to the male health providers experience, sympathy and knowledge of women health issues respectively. The respondents who prefer male health providers on the basis of their religion were 65(83.3%) (Table 3).

Table 3. Attributes for Preferred Provider’s Gender

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The socio-demographic variables were correlated with the choice of the gender of the health providers. The age, marital status, religion and ethnicity of the respondents all have significant relationship to the preference for health providers (p value <0.05) (Table 4).

Table 4. Sociodemographic Characteristics of Respondents by Obstetrics/Gynaecologists Gender Preferences

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In risk analysis conducted for selected variables that have significant chi-square, the respondents between 20-29 years of age are more likely to prefer female health providers {OR-8.427 (95% CI= 0.703 -19.002) p=0.014}.However, those between 40-49 years are less likely to prefer female health providers {OR= 1.134 (95% CI=0.246-5.231) P=0.872}. Married, Muslim respondents were more likely to chose female health providers {OR- 0.105 (95% CI= 0.05 –0.218) p=0.000 and OR-1.127 (95% 0.215 -5.923 respectively) (Table 5).

Table 5. Logistic Regression Model of Factors Predicting Preference for Female Health Providers

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In terms of male health providers preference, the respondents between 10-19 years of age were more likely to prefer male health providers {OR-2.001(95% 0.703 -19.002) but not statistically significant (p=0.550)}. The respondents between 50-59 years are less likely to prefer male health providers. The Yoruba’s are three times more likely to prefer male health providers (OR= 3.071, CI = 0.482-19.577) but the association is not statistically significant (Table 6).

Table 6. Logistic Regression Model of Factors Predicting Preference for Male Health Providers

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4. Discussion

In this study, there were disparities between the sex of doctors commonly seen by female patients in the Obstetrics/Gyneacology clinics and the sex of doctor preferred if given the options to choose. While majority of the women who visits the clinics for various gynecological issues are often seen by male doctors, more than half of these women have their preferences more in favour of female Gynaecologist/obstetricians if giving the option. Less than one third do not consider the sex of the health provider to be a determinant factor in their final choice of health provider. This finding is consistent with results of studies by Roter et al, where more than 50% was reported to exhibits preference for female doctors on health issues of gynecological nature²⁰ and other studies reported in different literature ^{[9, 10, 11, 14, 15, 19, 21]}.

Despite the apparent preference for female health providers, this study has also demonstrated that a certain number of women prefer male health providers; as 18.7% of the women indicated their preference for male doctors instead of female. This is comparable with the findings among female patients in other studies ^{[3, 13, 14, 15, 16]}. However, these findings are at variance with 4.0% reported among women in military population by Chandler ^[22] and 69.0% reported by Philips ^[23].

Regarding the attributes of female doctors, 79.0% opinioned that female doctors have better communication ability when it come to patient doctors relationship and interactions. Other significant attributes were knowledge of female doctors on women health issues, their experience and technical expertise, their sympathy for the patients and their religion. In similar studies conducted in other parts of the world, patients believe that female Obstetrician/Gynecologist is better. Amongst the reasons given includes: the female doctor’s passion for her patients, her humanitarian values, her knowledge and skills.^{[18, 21, 23, 24]}.

This study further established statistical relationship between the demographic variable of the respondents and their preference for their health provider’s gender. The age, ethnicity, religious beliefs and the marital status of the patient play a significant role in the choice of the gynecologist/obstetrician (p value <0.05). In the analysis of the strength of the relationship between provider’s preference and the predicting variables the age and religion of the women are the main predicting factors. Women between 20-29 years are about eight times more likely to see female doctor if giving the option(Table 5), while women between 30-39 years and those between 10-19 are three times and twice more likely to see male providers respectively. The Muslim women if given the option are more likely to prefer a female doctor to their male counterparts. From the mean age of the respondents (29.4 SD ± 11.2 years) and the marital status, it seems that the newly married women will prefer female health providers, and those who have stayed longer in marriage will prefer to see male health providers. This is comparable to findings from other studies where single women and women who have had children tend to prefer male gynecologists ^{[25, 26]}. On the contrary; the educational level of the women does not have any significant relationship to their preference for their health provider’s gender.

5. Conclusions

Majority of women who attends Obstetrics/ Gyneacology clinic are often seen by male gynecologist/ obstetricians, but most of them will prefer female gynecologist/obstetricians if giving the choice. The age and religion of women are the main contributing factors predicting provider’s gender preference.

Recommendations

We recommended that the Muslim women should be encourage to specialize in Obstetrics/Gyneacology to meet the needs of female Muslim Patients

Competing Interests

The authors declare no conflict of interest.

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